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Eimear Gency is a 2 year old girl who has presented to the paediatric assessment unit with a fever. She seems unwell and her parents are really worried. She has never been in hospital in the past.

Please take a history and perform a relevant examination on this child. You will then be asked to summarise your findings, present a differential diagnosis and discuss the case with the examiner.

You are the parent of Eimear Gency, a 2 year old girl. You’re worried sick, as for the past few days she has had a fever. She has now developed a red mouth, red hands and feet and sore eyes.

HPC: One week ago you noticed that Eimear suddenly felt very hot. You have a thermometer at home and took a temperature, which was 39.4˚C. Her temperature has been up and down over the past few days and has been really high. You gave her some paracetamol to try and bring the temperature down, but it didn’t seem to have much effect. It was at this point you decided to call 111. However, you couldn’t get through and were distracted by Eimear crying. Eimear has been generally unwell. She’s been crying a lot and has been really grumpy, it’s been a bit of a nightmare for you because she’s been up most nights and you haven’t had much sleep! Today you noticed her lips went really red and cracked and her tongue was also swollen up and very red. Then the skin around her hands and feet also went red and swollen before starting to peel. She also has redness around her bottom and she keeps scratching it. This isn’t new – she used to get bad nappy rash when she was younger – though it did look slightly different than this. It was all really distressing and you didn’t know what to do, so you brought her into hospital. Since you have been in the waiting room she has started rubbing at her eyes a lot and they also look red. You have also noticed some small, hard lumps on the left side of her neck.

She hasn’t had any cough, headache, diarrhoea or vomiting. Because she has been so grizzly she has been eating and drinking less than normal. Today she hasn’t eaten or drank anything because her mouth is so sore. She last went for a wee about 6 hours ago.

PMH: She is normally fit and well. She is up to date on her vaccinations.

She was born at 36 weeks with an emergency caesarean section because she had reduced movements. She was 5lb 8oz and required an overnight stay in an incubator but was otherwise well. You had no other complications during pregnancy. She has been growing well and hitting her developmental milestones.

DH: Eimear takes no regular medication and has no allergies.

FH: There is no relevant family history that you are aware of.

SH: Eimear lives at home with you and your partner. You moved from Japan four years ago, you are Irish, working as a a chef and your partner, originally from Japan, works for a technology company. You have no pets and neither of you smoke. Eimear will be starting nursery in a few months’ time.

ICE: You have no idea what could be causing Eimear to have these problems and you are really worried because it looks very sore and she seems very ill. You think it’s probably something serious and you are really scared for your little girl. You have brought her in to see a doctor in case it is something very serious so she can get the help she needs.

Please observe the student take a history from this patient. Ask them to present their findings and list their differentials, which should include Kawasaki’s disease.

Topics for discussion: • What are the diagnostic criteria for Kawasaki disease? • List some subsidiary features of the disease. • What investigations would you like to do and what might they show? • How would you manage this child? • What is the prognosis for Kawasaki disease? • What are some common complications of the disease?